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28 Cards in this Set
- Front
- Back
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Requirements of an immediate denture
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- Compatibility with surrounding oral environment
- Restoration of mastication within limits - Harmonious with speech, respiration and deglutition - Esthetically acceptable - Preserve remaining tissues |
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Immediate denture advantages and disadvantages
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Advantage:
- More willing to remove hopeless teeth - Spared the embarassment of being edentulous - Acts as bandage - Regain adequate speech, deglutition, and masticatory function sooner - Tongue, cheeks, lips, muscles of mastication have not been altered by lack of support - Establishment of vertical dimension of occlusion, esthetics, etc Disadvantages: - No opportunity to observe the anterior teeth so esthetics cannot be evaluated until insertion. Can use interim immediate approach. - More office visits required for post insertion care - Increased expense for patient |
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Contraindications of immediate denture
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- Lack of interest. Patient does not care if he goes toothless
- Poor health limits the number of extractions at one time - Financial limitations - Extremely irregular arrangement of natural teeth - Eccentric jaw relationships due to occlusal prematurities |
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Conventional immediate dentures
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Posterior teeth are removed and ridges are allowed to heal before impressions are made
- Intended to be the final denture |
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Interim (Transitional) immediate full dentures
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- Used for a short period for convenience, function, and condition the patient to acceptance of the prosthesis
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Immediate Interim (Transitional) removable partial denture
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Partial denture that is inserted at the time when only some teeth are extracted
- Used when natural teeth have an irregular arrangement that makes the use of an immediate full denture too unpredictable - Use teeth left in place for retention or to maintain maxillomandibular relationship |
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Stages of diagnosis
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Stage 1: Patient examination
- Review medical and dental history - Head and neck exam, Roentgenographic survey and panoramic - Articulated study casts in CR - Visual and digital exam - Exam existing prosthesis - Assessment of patient personality and reaction to dentists Stage 2: Consultation appointment - Reassessment of patient attitude, desires, and expectations - Coordinate diagnostic findings with patient desires and expectations - Discuss advantages and disadvantages of immediate denture - Achieve an understanding of patient's responsibilities in care and use of dentures - Discuss Fee - Patient approvale |
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Surgical preparation for immediate complete dentures
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- Removal of all max and mand posterior teeth with necessary alveoplasty
- Retain opposing bicuspids to maintain vertical dimension - Preserve bone and allow to heal without suturing for 8wks or loose sutures. |
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Materials for obtaining final impressions for immediate dentures
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- Split Keyed sectional trays
- Custom single tray - Custom posterior tray and alginate over impression - Single alginate impression |
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Setting anterior denture teeth
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- Draw long axis on each stone tooth extending the line to the edge of cast
- Number the stone teeth on alternate sides of the cast starting with a central - Cut away the stone teeth one at a time from alternate sides of the cast leaving two adjacent teeth to serve as guides for arrangement - Trim alveolar ridge to anticipate the amount of trimming to be done. Minimal trimming is best to preserve ridge - Position each artificial tooth onthe cast immediately after cutting away the corresponding stone tooth |
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Surgical Template
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Thin transparent resin base shaped to duplicate the form of the impression surface of an immediate denture
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Insertion and post insertion regimens for immediate denture service
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Day of insertion:
- Proper surgical protocol - Correction of basal seat, border areas and occlusion 24hrs post insertion - Removal of dentures for first time by dentist - Adjust basal seat, border areas, and occlusion 72hrs - Adjust basal seat, border areas, and occlusion 1wk - Most swelling is reduced - Adjust base and borders as required - Remount case to perfect occlusion - Reline with tissue conditioning material -Hard chairside reline after 3-6 months and recall one year after original insertion |
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Overdentures advantages
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- Maintain alveolar bone
- Sensory feedback - Improved masticatory function - Reduction of psychological trauma due to being rendered edentulous |
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Average reduction of ridge in edentulous cases and overdentures
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Over 25 years
Mandibular: 9-10mm Maxillary: 2.5-3mm Overdentures: For mandibular, overdenture lost only 0.6mm in anterior while conventional case lost 5.2mm over 5 years. Maxillary lost same |
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Tactile sensitivity discrimination
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Wearers of dentures are appx six times less efficient at detecting the presence of small objects between teeth
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Indications for overdentures
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- Single complete denture
- Cleft palates and surgical defects - Hypodontia - Extreme wear from attrition - Potentially unfavorable complete denture - Doubtful partial denture abutment |
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Preparation of abutments
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For immediate denture
- Abutment is prepared at the insertion visit, preferably before the surgical treatment |
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Overdenture abutments
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Slightly higher than the eventual preparation in the mouth
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Inserting overdenture
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Prepare abutments
Seal endodontic prep Extract incisors Ridge reduction only if necessary Insert denture |
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Day after insertion
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Final shaping and polishing of abutment surface
- Create sharp finishing line - Vent denture over abutments with a small round burr - Reline with cold curing acrylic resin or dual cure light curing resin - Remove flash from gingival crevice |
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Copings indications
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May be needed when:
- Caries develops on abutment - Shape of root does not allow a dome to be formed - Natural teeth oppose the abutment and there is occlusal parafunction |
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Preparation of dome copings
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Remove enough tooth so apex of dome will be no more than 2-3mm above the gingival margin
- Short post with anti-rotational notch |
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Thimble copings advantages and disadvantages
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- More retention and stability than domes
- No need for endodontic therapy Disadvantage: - Greater loading of clinical crown - Larger size is an obstacle for tooth placement |
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Mandibular two implant overdentures
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Usually adequately stabilized with a clip bar between two abutments
- Reduce rate of resorption of residual ridge - Implant survival rate in anterior mandible is high - Low incidence of surgical complications - Denture is stable and well retained - Less costly than multiple abutment cases |
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Multiple abutments
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Multiple 3-4 can stabilize denture and eliminate rotation around axis of the retaining bar
- Useful when narrow V shaped arch places implants too close together - More than 4 and we're doing a fixed or fixed removable case |
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Maxillary overdenture characteristics
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Because the bone is less dense, multiple implants connected by bars are suggested up to 4 instead of the 2 proposed in mandible.
Connect with a bar so prosthesis can still function if an implant is lost |
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Overdenture design guidlines
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Position implants so they are contained within the normal form of the denture base and centered beneath the prosthetic teeth.
- For anterior implants, a location slightly lingual to the center of the teeth is appropriate - Minimize height of the implant components and retentive mechanisms - When denture base will be thin or under heavy occlusal forces, use of metal reinforcement in the resin base will help prevent prosthesis fracture -Overdenture natural teeth should be reinforced |
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ZAAG
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two individual abutments
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